Ultrasonographic morphological diagnosis of chronic liver disease: 2-dimensional shear wave elastography as an add-on test

Correlation between Liver Ultrasonography with AST and ALT Value in Suspect Hepatitis

BACKGROUND: Liver ultrasonography is frequently recommended in Hepatitis patients. Hepatitis is liver inflammation caused by infection with microorganisms, drugs, and alcohol. Hepatitis causes liver cell damage and sometimes can change the echostructure of ultrasonography. These changes have affected the value of Aspartate Aminotransferase (AST) or Alanine Aminotransferase (ALT). AIM: The study aimed was to identify the correlation of liver ultrasonography with liver function (AST / ALT) in patients with suspected Hepatitis. METHOD OLOGY: The method was a Cross-Sectional approach to identify the relationship of liver ultrasonography, including echostructure, size, edge or surface, portal vein, gall bladder with AST and ALT in patients with suspected Hepatitis. The subjects were from PKU Muhammadiyah Hospital Yogyakarta, 2015-2018, 18-60 years old. They were identified using ALT and AST and proposed ultrasonography of the liver and gallbladder. The samples size consisted of 68 men and 32 women. Liver enzyme and ultrasonography did not know the results of this examination (blind). The relationship between the two variables was analyzed through the Chi-Square. RESULTS: The result was showed a significant relationship between liver ultrasonography, including the echostructure, size, portal vein dilatation with AST and ALT, and p-value for echo structure to AST 0.05 and ALT 0.02. The p-value of liver size revealed an AST of 0.03 and a p-value of a portal venous wall with AST 0.06 and with ALT of 0.02. CONCLUSIONS: There was a significant relationship between echostructure, liver size, and portal vein wall with AST and ALT. The liver surface edge and gallbladder had no significant relationship with AST and ALT.

Hepatic Elastometry and Glissonian Line in the Assessment of Liver Fibrosis

The aim of this study was to identify a method for staging hepatic fibrosis using a non-invasive, rapid and inexpensive technique based on ultrasound morphologic hepatic features. A total of 215 patients with different liver diseases underwent B-mode (2-D brightness mode) ultrasonography, vibration-controlled transient elastography, 2-D shear wave elastography and measurement of the controlled attenuation parameter with transient elastography. B-Mode images of the anterior margin of the left lobe were obtained and processed with automatic Genoa Line Quantification (GLQ) software based on a neural network for staging liver fibrosis. The accuracy of GLQ was 90.6% during model training and 78.9% in 38 different patients with concordant elastometric measures. Receiver operating characteristic curve analysis of GLQ performance using vibration-controlled transient elastography as a reference yielded areas under the curves of 0.851 for F ≥ F1, 0.793 for F ≥ F2, 0.784 for F ≥ F3 and 0.789 for F ≥ F4. GLQ has the potential to be a rapid, easy-to-perform and tolerable method in the staging of liver fibrosis.

Comparison of 2-D Shear Wave Elastography and Point Shear Wave Elastography for Assessing Liver Fibrosis

Progressive liver fibrosis may result in cirrhosis, portal hypertension and increased risk of hepatocellular carcinoma. We performed a meta-analysis to compare liver fibrosis staging in chronic liver disease patients using 2-D shear wave elastography (2-D SWE) and point shear wave elastography (pSWE). The PubMed, Web of Science and Cochrane Library databases were searched until May 31, 2020 for studies evaluating the diagnostic performance of 2-D SWE and pSWE in assessing liver fibrosis. Pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios and area under receiver operating characteristic curve were estimated using the bivariate random effects model. As a result, 71 studies with 11,345 patients were included in the analysis. The pooled sensitivities of 2-D SWE and pSWE significantly differed for the detection of significant fibrosis (F ≥ 2; 0.84 vs. 0.76, p < 0.001) and advanced fibrosis (F ≥ 3; 0.90 vs. 0.83, p = 0.003), but not for detection of cirrhosis (F = 4; 0.89 vs. 0.85, p = 0.090). The pooled specificities of 2-D SWE and pSWE did not significantly differ for detection of F ≥ 2 (0.81 vs. 0.79, p = 0.753), F ≥ 3 (0.87 vs. 0.83, p = 0.163) or F = 4 (0.87 vs. 0.84, p = 0.294). Both 2-D SWE and pSWE have high sensitivity and specificity for detecting each stage of liver fibrosis. Two-dimensional SWE has higher sensitivity than pSWE for detection of significant fibrosis and advanced fibrosis.